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My Internship

 

My internship with Traumatic Brain Injury (TBI) patients, at an out-patient day program on Long Island, started recently. I get very anxious before and after my hours, but the adrenalin rush gets me through while I’m actually working there. One of my favorite activities they do there is chair yoga, though, because it gives me a chance to breathe again. I wish I could bring Butterfly with me, for my own sake but also for some of the clients, who could use some of her ambient joy. One of the guys used to have a dog, but he can’t have a pet at all now, because his aide has allergies. If he could just sit with Butterfly for a little while each day, and whisper in her ear and pet her back, it could really help him. I know that it does wonders for me.

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Butterfly, my therapy dog.

The purpose of the day program is multiple: one, just to give the families of our clients a respite; two, to get the patients out of their homes and into social situations, so they don’t feel isolated and lonely; three, to fight off boredom and depression in whatever ways we can; and four, to continue, on a more causal and social basis, the work of speech, movement, and cognitive therapy that they can’t do on their own.

I am most interested in that last part, if only because it holds the most potential for my active participation. But for the clients, I think the most essential part of the program is the socializing part. At the day program they can practice their speech and memory skills without being laughed at (for the most part), and their brain injuries are taken for granted; they don’t have to compete with “normal” people for attention, or be embarrassed or ashamed by what they can’t do.

The structure of our days at the program is a bit loosey goosey, but the clients’ favorite activities, over all, seem to be games: guessing games, Hangman, Pictionary, Jenga, Connect Four, Uno, etc. They’re laughing and testing their social skills and showing off. It reminds me of kindergarten, though, with games like Duck Duck Goose and Musical Chairs, which I found extremely stressful. Those games seemed to exaggerate the possibility of rejection for me, rather than mitigate it. But the other interns, and even more so our supervisor, are much more comfortable with this part of the work. They enjoy the games and know how to stay upbeat and playful, pushing back against the depression and stuckness that might otherwise prevail in the room.

I do well with the clients one on one, and in casual situations, because I’m genuinely curious about them, but I’m afraid of how I’ll manage running a workshop or exercise from the front of the room. I wish I could practice some of my group-running skills on the dogs, but, first of all, Cricket is not a joiner, and second, they can’t hold pens in their paws, or answer my questions in words, so a lot of the exercises would be lost on them.

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Cricket is not a joiner.

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Unfortunately, dogs can’t write.

My supervisor suggested that I use my writing background with the clients in some way: so I collected poems and song lyrics the clients might relate to; and I printed out a page of Cricket pictures so that they can identify the emotions on her face, and make up stories about what happened before the picture was taken (I’m hoping her faces will be a good instigator for discussions on anger and anxiety and joy and relief, all kinds of things they wouldn’t automatically discuss with each other out of the blue); and I made up a list of autobiographical questions for the clients to answer and turn into short essays; and then there’s a group exercise in storytelling; and then I did research on hand drumming and handclapping therapy; and I made up a quilting pattern exercise, using fabric and paper and glue. So, at least I’ve found an outlet for all of my nervous energy.

Early on, my supervisor warned me and my fellow interns that some of the clients can be manipulative, and we shouldn’t believe them when they say this or that, and they don’t want to be challenged, and they can do more than they’ll admit, and on and on. Even if all of those things are true, it’s never as simple as all that. Motivation plays a huge role in what people can and can’t do. That’s not being manipulative, it’s about genuinely needing a reason to take an action and not wanting to just do what someone tells you to do.

Depression also plays a big role. The brain trauma itself can cause depression, and so can some of the medications they need to take to control their symptoms, but there’s also the depression that comes from having your life plan obliterated, and your sense of your place in society taken away from you. It is much harder to figure out motivation when you know that you can’t meet your own goals, no matter how hard you try. You need to not only come up with a new set of goals, but you have to accept that those goals will be very modest compared to the people around you. There’s an expectation that these clients should feel grateful that they have a day program to go to, and people who will pay attention to them, but that kind of gratitude can be hard to come by when you feel like so much has been taken away from you.

I’ve learned a lot from Cricket about how to accept bad behavior that isn’t meant to be hurtful. Her short-circuited nervous system means that she has low frustration tolerance, so she will use whatever behaviors she can think of to relieve her anxiety. She doesn’t mean to be a hellion; she just wants to feel better.

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Cricket just wants to feel better.

I’m enjoying the work, but it’s exhausting. When I came home from my first long day at work (Nine AM to Three PM feels long to me), Butterfly was out of her mind with excitement. She’s not used to me being away for so long and it felt great to be getting such a greeting; those are usually reserved for Grandma after she’s been out gardening for five minutes. She ran around in circles and bumped into her sister, who was hopping and panting and trying to sniff my shoes herself. It’s nice to be celebrated every once in a while.

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“Mommy! You’re home!”

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About rachelmankowitz

I am a fiction writer, a writing coach, and an obsessive chronicler of my dogs' lives.

96 responses »

  1. I am excited for you, it sounds pretty wonderful as an internship. I’d be tired too, Butterfly is so cute, I’m sure she gives the best welcome home.

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  2. What a great post, Rachel. I love all the activities that you have planned but mostly that you have pictures of Cricket for the patients. ‘Cricket is not a joiner’ made me chuckle. I think this will be a great exercise for them. And this work sounds so rewarding. Good luck with this; you sound like you are enjoying it.

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    • I really am enjoying some of it, and finding other parts challenging, which is great. The more I can bring the dogs into the work, I think, the better it will be for me, and for the clients too.

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  3. I love this! it is so true that most people don’t mean to be hurtful but are just trying to feel better. The feeling of coming home to a soul that is so excited to have you back is, well, exhilarating! I think your techniques to use storytelling and creative writing is perfect for the group you are working with. I bet they did well! Good luck, have fun and kisses to both Cricket and Butterfly. Buddy and Ginger are missing me now when I go to work too.

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  4. It’s too bad you can’t take your pups to work. I know they can be very therapeutic for people with ailments

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  5. A great expression. Thanks.

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  6. Rachel I don’t know if you are familiar with the old movie Captain Newman MD. While reading this I thought of Tony Curtis’s character Corporal Liebowitz who is manipulted into working the psych ward. When the nurse asks the doctor why he thinks he;ll make a great orderly the answer is “Because he understands suffering” I think of all your worries and yet you go right in there and have such compassion and thoughtfuless about the patients. They are lucky to have you and it really is too bad you can’t share your therapy dog.

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  7. The possibility of some kind of writing exercises seems very exciting to me…I think there’s a brain connection forged by the act of writing. I love that your mentor is using your strengths.

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  8. You bring kindness and empathy to such a difficult job. Props for leaving your comfort zone to help others. That program needs compassionate people like you who wont listen to the negative generalizations and assumptions about people in need.

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  9. Have fun learning with your internship. I recall my internships were a chance to try new things and adjust what I did till it worked. I am guessing that the clients know you are an intern so they maybe a little more forgiving. Most states have some sort of therapy dog association, I bet there are a few dogs on long island who might come out to your location.

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    • I’m not sure if the clients are planning to be forgiving, but I will definitely keep trying until I figure out what works for them. We’re not allowed to have animals on site at all for some reason. Totally sucks.

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  10. Hi, Rachel. Very poignant to read of your adventures out in “The World”. To extend to others, especially those with disabilities, despite your inner concerns…that’s really something. Extraordinary, really.

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  11. Three Pups and a Couple of Kitties

    You’ve have done a lot of work for your internship already. I love your ideas, and I look forward to reading your updates.
    What an awesome welcome home from Butterfly! Love her smiley little face.
    ~ Margret

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  12. Good on you for extending yourself to support people with brain traumas. It would be very exhausting, but rewarding too, and so important for them. And then to get the hero’s welcome from the dogs. A good day all round.

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  13. Such great work you are doing, so meaningful. Hard too, working with people who have suffered a TBI. I love how happy Cricket is to see you!

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  14. What a great place to contribute! And yes, one of dogs’ most endearing qualities (to me too) is their enthusiastic greetings when I come home.

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    • It’s exciting to see the variety of agencies out there solely meant to help people. I’ve been able to hear from the other interns about their previous placements and it’s just fascinating.

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  15. If they’re allergic to dogs, try us parrots. We’re love birds. SQUAAAAAAAAAWK!

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  16. Aw I wish you could actually really physically bring the dogs into work.I’m sure they would bring so much joy and fun to the clients. Having a dog pal myself,I know they are so theraputic.Love that you are getting a big welcome home though.Thats one of the best things about sharing your home with a pooch.:)))

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  17. One of the things I learned when Jim had brain cancer was that he was not aware (or as aware as I was) of his brain damage. I would cut him extra slack because it was obvious that his brain was not telling him of some limitation or processing issue. Good luck with the internship. I think your writing background will be a great gift–and your empathy for those who don’t like competitive games.

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  18. Agree with Rachel, there is nothing like stroking a dog to reduce stress. The world would be better if we all could start each day by loving up our dogs. It works for those facing neurological challenges as well. In my 40 years of practicing neurology, I heard many testimonials as to the beneficial effect of dogs.

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    • I was heartbroken when the one client told me he couldn’t have a dog because of his current living situation. Not only because he’s missing something wonderful, but because he knows exactly what he’s missing.

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  19. This all sounds so exciting: well done, Rachel, and good luck with the group sessions. You’ll be great! Pip and the boys

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  20. I used to take our cocker spaniel Blondie to visit the folks I volunteered to spend time with in a the secure wing at our local home for the elderly/rehab center. They would just light up! They also loved the stuffed dogs I made and brought in for them. Treated them like they were alive! You know what popped into my head when you were talking about using your writing background to work with the clients? A storybook with pictures of your dogs. Put together a storybook and use pictures of your dogs as illustrations. I had thought about doing something like that once. Don’t know if that resonates as you are incredibly busy but just wanted to pass on the “intel” 🙂 Thank you and bless you for your chosen career path!

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  21. Work with disabled adults seems like such a difficult task, and I have such respect for the people who do it. It’s great that you have your own “therapy dogs” (especially Butterfly’s enthusiastic welcomes!) to come home to. I agree with some of your other commenters that it would be great if you could somehow involve trained therapy dogs in your work. Maybe, ultimately, that is where you need to find your “calling” – working with dogs AND people!

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  22. Lovely post! As usual, you do a great job of weaving in your dogs’ behavior and personalities to make several good points. Your clients/patients are lucky to have you.

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  23. Butterfly always looks so joyful! Not to minimize Cricket, who is gorgeous, but Cricket reminds me of me…a bit stand-offish and (like the picture) giving clear signs that she needs some ‘alone time’ now and then. I’m not clear – is there some reason that Butterfly can’t be utilized as a therapy dog (at least once)?…it’s a unique way of connecting with the patients there. If it were properly set-up before hand (maybe with your mother ready to take her home again after a set time), it seems to me that it might do a lot of good. And don’t worry unduly about the having to run things bit when it’s your turn, or being ‘in charge’ … I’ve found we rise to the things we have to do that are out of our comfort zone (I loathe public speaking, but have found that I get through okay with preparation). I think it’s wonderful you are doing this for your career! Working with TBI patients is never easy and it’s a field of health care that’s woefully understaffed. 🙂

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    • For some reason, the place where the program is located can’t allow even licensed therapy dogs. And Butterfly isn’t trained. She’s likely to pee on the floor to make herself feel more at home.

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  24. Best of luck on your internship! You’re fur babies are beautiful.

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  25. If that’s true about the guy who can’t have a dog because his aide has allergies – unless “aide” means (unpaid, friend or family) carer – why not change the aide?

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  26. Sounds as if you’re doing really well. Just remember to look after yourself too.

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  27. Thank you for this, Rachel. In my work, I deal with referrals to adult day programs. It is somewhat abstract until painted in vivid color as you have done. I will often stop to think of this post.

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    • I’m so glad! Every program is different, especially depending on the population being served (developmental disabilities, mental illness, senior care, etc.). My supervisor used to be a service coordinator, and recommended people to this program in her previous life, without really knowing what it was like. There’s lot to be said for service coordinators getting a chance to visit the day programs in person, to see for themselves who will fit best where.

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  28. Sounds like a great internship. I think dogs have very expressive faces and can convey much. I had a stroke in 2003, so understand brain issues. It took a while but I worked my way back with the help of therapists, understanding co-workers and dogs, and David of course.

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  29. Wow! You’re doing such an amazing thing here. Totally normal to have some anxiety about parts of it. And I’m glad you’ve got your therapy dogs to come home to ;-P

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  30. Love this post as it takes me somewhere I’ve never been. So sad that even therapy dogs aren’t allowed everywhere. I should be more understanding of people with fears & allergies, but its not easy when dogs are so wonderful.

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  31. Congratulations on your new and exciting pathway through life. Glad that you are still spending quality time with Butterfly and Cricket. 🙂

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  32. I wish you all the best with you internship!

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  33. I am impressed by your kindness and feel humbled by the very worthwhile work you are doing. I agree that dogs would help some of the clients relax and relieve their stressing levels. . I am happy to hear that your two are so extra welcoming on your return as it must be a stree filled day for you.

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  34. I always enjoy reading your posts! I hope you don’t mind, but I love this sentence, “She doesn’t mean to be a hellion; she just wants to feel better.” I may have to use it 🙂

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  35. Hi Rachel,
    I really enjoyed reading your post and seeing things from “the other side”. I’ve been through rehab after getting my shunt and attended a memory group. What I found most useful is using a diary to remember things and plan my day and I was encouraged to write a few things that went well each day. My daughter’s teacher did this at school and they had their WWW Book…the What Went Well Book. This can be done easily with a week to a page diary. I’ve been meaning to do that myself. I bought the diary.
    You have a really good understanding of what it is to have your life derailed. I have come to appreciate how important it is to have your situation acknowledged.
    Anger is also a huge issue both due to what happened but also due to frontal lobe issues and being disinhibited.
    I think your group members would love meeting and patting your dogs. My dogs really help me and our whole family.
    You’ll do really well at this and the most important thing is that you care and your clients feel accepted and beyond that, things will fall into place. You don’t need to be perfect!!
    All the best,
    xx Rowena

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    • Some of the clients are really good about writing things down in their daily journals, others, not so much. Yesterday I was reminding one guy to follow the instructions on his journal (write at least one thing a day) and he just rolled his eyes at me, which is probably who he was before his injury too. I guess snottiness survives brain trauma. Who knew?

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  36. Wow, I really admire that you are taking on such challenging work. I think it’s only natural to feel nervous, but the list of activities you’ve come up with for your clients sounds great, especially the doggie facial expressions 🙂

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  37. It’s a shame that some people can’t interact with Butterfly. She look like the perfect therapy dog. I would want to stroke her!
    Best wishes, Pete.

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  38. As I was reading, I forgot you were talking about Traumatic Brain Injury (TBI) patients because they sounded so much like the older population I once worked with. So many of the same stuff. Nice of your supervisor to encourage you to use your writing background with the clients in some way. And, it sounds like you came up with great stuff!

    Sounds like wonderful work you are doing!

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  39. I’ve had two brain surgeries. I wouldn’t recommend it. It is much easier to write than to talk. I prefer texting to talking on the phone.

    I must say, if the man’s aide is allergic than he needs a new aide. Recovery is bloody awful. Pets are so very important in helping one get through the petty indignities and daily trauma and the life-sucking depression. When my rescue cat, a Turkish Angora, died I searched across the country looking for another breeder that could guarantee such a calm, affectionate, devoted cat. I tried to adopt a retired adult but none were available so I spent a ridiculous amount on a kitten for the guaranteed constant companionship. I’ve had 3 Turks now. They choose one person and become devoted to That person, rarely leaving their side. To have that love and attention in your darkest hours is priceless.

    And that last photo of your dog, priceless.

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    • Those Turkish Angoras sound wonderful! I think it’s that bone-sucking depression that keeps people stuck, no matter what their physical disabilities. And there’s just so much medication can do to break the dam.

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  40. I really like the idea of using the dog’s faces to stimulate imagination .
    Well done.

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  41. It sounds like a fascinating job! I am really interested in the human brain, the amazing way that it works and so forth. Especially since my Dad had a stroke last spring.

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  42. Rachel, you have so much empathy which is perfect for this internship! I once assisted with a writing group for people with ABI – we had so much fun and a few tears along the way. The people who could hold a pen wrote short exercises, others talked while someone wrote for them, and I worked with one guy who typed on his Litewriter with just his little finger. Creativity is definitely not stymied by brain injury; and it’s brilliant when people can express their emotions in a safe place where everyone understands 🙂 Good luck with it all, you’ll be great!

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